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Medicare Advantage plans not always a good deal

New York City, May 19, 2006--Beneficiaries in poor health can pay more out of pocket for care in Medicare Advantage (MA) managed care plans than in traditional Medicare with Medigap supplemental coverage, a new Commonwealth Fund report finds. The report says beneficiaries in poor health can spend up to $2,195 more in annual out-of-pocket costs for their care in 19 out of 88 plans than they would have in fee-for-service Medicare with Medigap supplemental coverage.

In Medicare Beneficiary Out-of-Pocket Costs: Are Medicare Advantage Plans a Better Deal? Brian Biles and Lauren Hersch Nicholas of George Washington University and the Fund's Stuart Guterman compared estimated out-of-pocket costs for 88 MA and Medigap F plans in 44 areas across the nation. They found costs for beneficiaries in good health lower in all 88 MA plans and, for those in fair health, all but two MA plans had lower costs than fee-for-service plans. But for beneficiaries in poor health, 19 of the 88 plans had higher out-of-pocket costs than they would have had in traditional Medicare with a Medigap supplement. The authors conclude that "the benefit packages offered by MA plans often result in substantial out-of-pocket costs for beneficiaries in poor health."

In the MA plan with the least financial protection, MA plan enrollees in poor health faced $7,522 in annual out-of-pocket costs, compared with $5,606 in traditional Medicare with a Medigap F plan, a difference of $1,916. In the MA plan with the best protection for enrollees in poor health, annual out-of-pocket costs were $1,359 in the MA plan compared with $5,984 in the traditional Medicare plus Medigap Plan F coverage.

As a result of policies enacted as part of the Medicare Modernization Act of 2003, Medicare paid MA plans an average of $800 extra per enrollee in 2005, to let MA plans improve their benefit package by lowering premiums and cost-sharing. The new study shows that, despite those richer benefits, many benefi
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Contact: Mary Mahon
mm@cmwf.org
212-606-3853
Commonwealth Fund
19-May-2006


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